Anatomy, Abdomen and Pelvis, Genitofemoral Nerve


Article Author:
Marco Gupton


Article Editor:
Matthew Varacallo


Editors In Chief:
Stephen Leslie
Karim Hamawy


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Kyle Blair
Trevor Nezwek
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Daniyal Ameen
Altif Muneeb
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes
Komal Shaheen
Sandeep Sekhon


Updated:
4/5/2019 1:11:03 PM

Introduction

The genitofemoral nerve arises from the lumbar plexus. It supplies sensation to the skin of the anterior scrotal area in males, mons pubis in females, and the upper segment of the anterior thigh in both males and females. While distinct from the femoral nerve, the genitofemoral nerve originates from the upper lumbar segments L1-L2. It then descends inferiorly, piercing the psoas major muscle before emerging on its anterior surface. The nerve then traverses the retroperitoneum, descending over the anterior surface of the psoas muscle. The nerve continues inferiorly ultimately separating into two divisions- the femoral and the genital branches. When the genitofemoral nerve reaches the groin area, it enters the deep inguinal ring coursing through the inguinal canal.[1][2]

In males, the nerve continues inferiorly and supplies the skin of the scrotum.

In females, the genitofemoral nerve runs alongside the round ligament of the uterus and terminates just superior to the mons pubis and labia majora. Further, after crossing the inguinal ligament, the genitofemoral nerve travels adjacent to the external iliac artery, supplying sensation to the anterior upper thigh.[3]

Structure and Function

The genitofemoral nerve supplies sensation via the femoral branch and motor innervation via the genital branch. The cremasteric reflex is a function of genitofemoral nerve innervation, as it supplies sensation to the superior medial aspect of the thigh. In at least 50% of individuals, there is some variation in the course of the genitofemoral nerve as it travels within the retroperitoneum and ultimately entering into the inguinal canal. Variation is also found at the level of its bifurcation into genital and femoral branches.  

Blood Supply and Lymphatics

The genitofemoral nerve is formed in the midsection of the psoas muscle by the union of branches from the anterior rami of L1 and L2 nerve roots.  The nerve then courses inferiorly within the psoas muscle and finally emerges on the anterior surface of the muscle distally. The nerve then descends inferiorly in the retroperitoneum along the psoas major muscle and just courses deeper and on the left to the gonadal vessels, ureter and the ileocolic vein and artery.

Just before the nerve reaches the inguinal ligament, both the right and left genitofemoral nerves perforate the psoas fascia, and then divide into the femoral and genital branches.

Nerves

The genital branch of the genitofemoral nerve enters the inguinal canal via the deep inguinal ring. In males, the genital branch supplies the scrotal skin and cremaster. In females, the genital branch is accompanied by the round ligament of the uterus and supplies sensation to the labia majora and mons pubis.

The femoral branch of the genitofemoral nerve travels beneath the inguinal ligament in the lateral muscular compartment, where the femoral nerve courses though into the leg. The femoral branch enters the cribriform fascia of the greater saphenous vein opening and supplies the skin of the anterior, upper and medial aspects of the thigh.

Physiologic Variants

Cadaveric studies have reported significant variation in the course of the genitofemoral nerve in over half of specimens. 

While the majority of specimens exhibit a predictable bifurcation pattern of the nerve in the mid-substance of the psoas muscle, a recent study noted that the genitofemoral nerve prematurely bifurcates in the upper portion of the psoas muscle about 20% of the time.  In addition, the femoral and genital branches do not form a common trunk within the psoas muscle and remain as distinct nerves as they course in the retroperitoneum.

Surgical Considerations

Inguinal hernia repair

During surgery for repair of an inguinal hernia, one has to visualize the genitofemoral nerve which is found within the deep inguinal ring. If damaged, the patient will complain of pain in the scrotal area and anterior thigh. The injury can result in genitofemoral neuralgia causing morbidity as no good treatment currently exists.  For exam purposes, one has to differentiate between the genitofemoral and ilioinguinal nerves, both of which can be injured during surgery.[4][5][6]

Lumbar spinal interbody fusion

During lumbar spine surgical procedures, the surgeon must be aware of the anatomic relationships between the lumbar plexus and the intervertebral disc at all levels.  This concept is particularly relevant when performing lateral interbody fusion by minimally invasive retroperitoneal transpsoas approaches.  Ventral nerve roots of the lumbar plexus are particularly vulnerable during psoas muscle retraction.  Surgeons must be aware of the "safe working zone" as it pertains to the particular level of interest with respect to the level of pathology being treated.  This "safe zone" is typically located between the anterior border of the lumbar nerve and the posterior border of the sympathetic trunk.  The genitofemoral nerve appears to be solely responsible for narrowing this safe zone with its most significant anatomic impact being recognized at the L2-L3 level.

Clinical Significance

The genitofemoral nerve can be injured during surgery in several ways:

  • It can be lacerated during injury to the groin. This can occur with penetrating trauma, a knife wound or surgical exploration of the groin. In some cases, during surgery on the saphenous vein for varicose vein ligation, retractors can cause abrasive injury.
  • The genitofemoral nerve can also be injured in the inguinal canal, usually during inguinal hernia repair. In most cases, the injury is unnoticed during surgery and diagnosed in the post operative period when the patient complains of pain.
  • The genitofemoral nerve can also be injured during a motor vehicle accident. The lower back injury may result in an extension of the back while the patient is seated.
  • Lifting heavy objects can also cause injury to the genitofemoral nerve.
  • When there is spinal stenosis of the L1 or L2 segments, compression fracture or metastatic lesions to the lumbar spine the nerve roots which give rise to the genitofemoral nerve can be injured.
  • Psoas abscess which may occur after an open pelvic fracture or a retroperitoneal hematoma is also known to cause irritation of the genitofemoral nerve.

Other Issues

Genitofemoral neuralgia is a relatively common pain syndrome observed in both males and females. The patient typically presents with unilateral pain in the lower abdomen. Rarely the pain may be bilateral. The pain is sometimes referred to the groin area (because of the path of the genital nerve) and the upper medial thigh (because of the femoral branch). The pain varies in intensity from moderate to severe and is worsened by movements that cause extension of the lower back. In most patients, palpation of the lower abdomen in the inguinal region can reproduce the pain. In most cases, the cause is compression of the nerve in the inguinal canal, usually after open hernia surgery. The diagnosis is often difficult in patients who have not had surgery.[7][8]

The prognosis of patients who suffer entrapment or injury to the genitofemoral nerve is guarded. If the nerve is entrapped in the inguinal canal after inguinal hernia surgery, one may try decompression, but often the scarring makes visualization of the nerve difficult.

In patients with a lacerated nerve, many pain relieving modalities have been used, but none works effectively. Some patients do respond to nerve blocks, but the majority of patients require long-term anticonvulsants and opiates for pain relief.  


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Anatomy, Abdomen and Pelvis, Genitofemoral Nerve - Questions

Take a quiz of the questions on this article.

Take Quiz
Which of the following statements about the genitofemoral nerve is false?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which nerve arises from the L1-L2 roots, then runs downward through the psoas major, and later at the level of the inguinal ligament, divides into branches that innervate the skin of the anterior surface of the thigh and the cremaster muscle?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Where is the genitofemoral nerve found in the groin area?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the best location to block the genitofemoral nerve?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 27-year-old male presented to his clinician complaining of groin pain and swelling of the testicles that enlarges when the patient stands or coughs. The clinician determines that this is an indirect inguinal hernia and recommends surgical repair. During the surgery, a nerve that runs inside the spermatic cord is injured. Which of the following additional findings is most likely to be present in this patient?

(Move Mouse on Image to Enlarge)
  • Image 4977 Not availableImage 4977 Not available
    Contributed by Wikimedia Commons, OldakQuill, NASA (PD-USGov)
Attributed To: Contributed by Wikimedia Commons, OldakQuill, NASA (PD-USGov)



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following surgeries most commonly causes injury to the genitofemoral nerve?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Anatomy, Abdomen and Pelvis, Genitofemoral Nerve - References

References

Lew V,Kang M, Anatomy, Abdomen and Pelvis, Femoral Sheath 2019 Jan;     [PubMed]
Benes J,Nádvornik P,Dolezel J, Abdominoinguinal pain syndrome treated by centrocentral anastomosis. Acta neurochirurgica. 2000;     [PubMed]
Lee KS,Sin JM,Patil PP,Hanna AS,Greenberg JA,Zea RD,Brace CL, Ultrasound-Guided Microwave Ablation for the Management of Inguinal Neuralgia: A Preliminary Study with 1-Year Follow-up. Journal of vascular and interventional radiology : JVIR. 2019 Feb;     [PubMed]
Iwanaga J,Simonds E,Schumacher M,Kikuta S,Watanabe K,Tubbs RS, Revisiting the genital and femoral branches of the genitofemoral nerve: Suggestion for a more accurate terminology. Clinical anatomy (New York, N.Y.). 2019 Apr;     [PubMed]
Cirocchi R,Henry BM,Mercurio I,Tomaszewski KA,Palumbo P,Stabile A,Lancia M,Randolph J, Is it possible to identify the inguinal nerves during hernioplasty? A systematic review of the literature and meta-analysis of cadaveric and surgical studies. Hernia : the journal of hernias and abdominal wall surgery. 2018 Dec 20;     [PubMed]
Mellick LB,Al-Dhahir MA, Cremasteric Reflex 2019 Jan;     [PubMed]
Zhu CL,Zhong H,Li CH, [Anatomic application of the genitofemoral nerve in uroandrological surgery]. Zhonghua nan ke xue = National journal of andrology. 2017 Mar;     [PubMed]
Narita M,Jikihara S,Hata H,Matsusue R,Yamaguchi T,Otani T,Ikai I, Surgical experience of laparoscopic retroperitoneal triple neurectomy for a patient with chronic neuropathic inguinodynia. International journal of surgery case reports. 2017;     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Surgery-Urologic. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Surgery-Urologic, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Surgery-Urologic, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Surgery-Urologic. When it is time for the Surgery-Urologic board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Surgery-Urologic.